Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00221
Date Issued: 08/13/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112CC21600
Jurisdiction: TIG
Site address: 15629 SW 81ST AVE
Subdivision: Gage Forest Lot: 23
Project: GAGE FOREST
Project Description: Irrigation backflow.
Owner: FEES
TIMBERLAND HOMES INC Quantity Description Date Amount
12670 SW 68TH AVE
TIGARD, OR 97223 1 ea Backflow Prevention - RES 08/13/2009 $27.55
1 12% State Surcharge - 08/13/2009 $4.35
PHONE: 503 - 620 -8860 Plumbing
9 ea Minimum Fee Adjustment - 08/13/2009 $8.70
Plumbing
Contractor:
REDWOOD LANE NURSERY
8222 BROADACRES RD
WOODBURN, OR 97071
PHONE: 503 - 678 -3242
FAX: 503- 678 -3252
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $40.60
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ��JJ �w
Issued By: "�� Permittee Signature: - Q �s
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
08_11 -'09 10:54 FROM- ����I V T -146 P002(003 F -094
/' fin✓ km / �f� / //^ V
y Rec
City of Tigard I I 1 200 Date/By: P ermit No.:
■ 13125 SW Hall Blvd., Tigard, OR 97223
AUG 3 1 O�'r.3� 9 ,/ �U/�On� ��� 02/
ti Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 TIGARD Date/By: ° ` "' NO S /o /�S
Inspection Line: 503.6394175 CITE OF w to Rcad !s runs: H See 2 for
C!l„11:17 Internet: ww.tigard- or.gov BI1ILDINGDIVI tificd/Method: T / � Supplemental Information
_
TYPE OF WORK A7 . FEE* SCHEDULE
ew construction 0 Demolition For special information we checklist.
• - ---- -w Dcscri 1 Qty. I I B. Total
El Addition/alteration/replacement 0 Other: - New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
RI"- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
[] Other:
- Fire sprinkler L_ sq, ft.) Page 2
.IOB SITE INFORMATION AND LOCATION Site utilities
Job site address: . P--- Catch basin or area drain 16.60
City /State/ZIP: J e- e /4- 1 ) L.2_3 Dtywell, leach line, or trench drain 16.60
L 1 � ir Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: 1/
Manufactured borne utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16,60
Sanitary sewer (no. linear ft.: . ) Page 2
Storm sewer (no. linear ft.: ) Pa 2
1�. Water service (no. linear ft -: ) Page 2 2.3 Subdivision: • a'S` l Lot no -:
Tax map /parcel no.:
Fixture or item
- �-- -� - Absorption valve 16.60
_
DESCRIPTION OF WORK Backflow preventer Page 2
-
Backwater valve 16.60
" Clothes washer 16.60
' Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
1 n Ejectors /sump 16.60
Name: �f �� O G Expansion tank 16.60
Address: ( 7 � i
0 .) (t2 _3 D Fixture/sewer cap 16.60
City /State/ZI3': L' ) `� 2 u-3 Floor drain/floor sink/hub 16.60
TLt" .t--4( _
Phone: ( so ) 0 '�.-- 4 , (J Fax: ( e �--5 f } 4 Garbage disposal -w 16.60
0 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name:
Ice maker 16.60
- Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer _ I6.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) • Fax: : ( ) Sink/basin/lavatory M» 16.60
E -mail. Tub /shower /shower part 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: C.p w Water heater ., 16,60
^ (Vela r" v� � � ��
Address: 9 4_2_2_ ® ✓r,,
,, •CC -i'9, /5 y Other: •
City /State/ZIP: , `� D . Subtotal
Minimum permit fee: 572.50 �-'
Phone: ( 5 3) . y. 3 2 ,�� �. /Fax: ( ) b ?t"' 5 Residential backflow minimum permit fee: $36.25 3 C. L •C Lic.: / G15 . -10e Plumbing Lic. no.: Platt review (25 %ofpermit
Authorized signature: 1.---' --- State surcharge (12 %ofpermit fee) 3
d TOTAL PERMIT FEE 9),
Print name: , � .� lc Date: i� 1,L e This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industn Service Board.
r; 113ui ldieg1Pcrmital PLMU- PermitA,p.doe 1227,t4 440- 4616T(10/02/COM /wE6)
1